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Hot or cold: What’s best for pain?
Whether you’re hurting from knee pain, a stiff shoulder, elbow tendonitis, arthritis or a recent minor injury, it doesn’t matter…
What does matter is stopping the pain.
If it’s bearable and you want to get relief without running to the doctor’s office, there are a few things to try.
Commonly, hot or cold therapy can help, but if you’re dealing with an acute injury, like a banged up knee from a game of tennis gone bad, or chronic aches and pains that come and go, how do you know whether heat or cold is the appropriate treatment?
It’s all about blood flow, says Dr. Scott Lynch, director of sports medicine at Penn State Hershey Medical Center. You may have heard about the acronym prescribed for many injuries — RICE. That stands for rest, ice, compression, and elevation.
“Elevation is probably the most important thing because it limits the amount of blood flow to the area and reduces the amount of swelling,” Lynch says.
But after that, well it gets tricky…
When cold is best
Cold helps constrict, or narrow, blood vessels so blood won’t accumulate where you’re hurting, potentially causing inflammation or swelling that could delay the healing process.
Applying ice to an injury during the first 48 to 72 hours after occurrence can reduce the amount of secondary tissue damage and help decrease pain. Experts recommend icing for about 20 minutes every hour. Be careful not to damage skin with excessive cold, which can happen with chemical freezer packs) and give your body time to recover between icing sessions.
You can purchase flexible ice packs that are easy to apply to joints (some have Velcro to hold them in place). These can be molded around an injury for better coverage. Otherwise, you can use an old fashioned ice bag, freeze water in zipper bags, or use a bag of frozen vegetables.
Applying heat
Heat is best used to alleviate muscle aches and pains or to loosen tense and sore areas before activity. “Heat encourages blood flow to the area, which provides nutrients that the tissues need for healing, says Dr. Cayce Onks, family and sports medicine physician at Penn State Hershey Medical Center.
If you have chronic issues or old injuries, heat before activity and ice afterwards may be the best combination. Some people prefer moist heat (hot shower or damp towel, for example) to help with penetration of warmth. A heating pad or corn pack you put in the microwave work well, too.
Commercially available patches, creams, or other products that produce heat may provide superficial relief, but they don’t penetrate as well as ice, moist heat, or ultrasound (used by athletes or in physical therapy). But if the temporary relief is helpful, there’s no harm in using them.
Bottom line: For chronic injuries, use what helps you feel better. For an acute injury, experts say the cold from ice is best.
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